tbuckley/cabot-search huggingface dataset:
Abstract 19190: The Impact of Donor Age on Long-Term Survival After Heart Transplantation: A Modern Analysis of the Unos Database
Authors: Mohammad K Fatmi, Akanksha Agrawal, Benjamin Mackie, Lucian Lozonschi
Journal: Circulation (2023)

Introduction: Despite innovations in organ procurement and preservation, heart transplantation (HT) remains challenged with paucity of donor organs. Data is limited regarding the influence of donor age on long term outcomes of HT. Hypothesis: Our aim was to investigate the impact of donor age on long-term survival of transplant recipients between the past two decades. We hypothesized that the probability of survival has increased significantly over the most recent decade with significant increases in survivability for donor hearts aged 55+ years. Methods: The UNOS heart transplant registry was used to analyze survival of heart transplant patients between 2000-2009 (N= 10178) and 2010-2019 (N=20990). These were further separated into three donor age groups: 18-34, 35-54, and over 55 years. Kaplan-Meier survival curves were generated over a 10-year period. Log-ranked statistical testing was used to test the survival curves for significance. Results: Between 2000-2009, 5895 (58%) HT were performed from donors aged 18-34, 3862 (38%) HT from ages 35-54, and 422 (4%) HT from age 55+ group. The chance of 10-year survival was 62%, 52% and 40% respectively.In the 2010-2019 era, there were 12993 (62%) HT performed from donors aged 18-34, 7363 (35%) from ages 35-54, and 634 (3%) from age 55+ group. The 10-year survival was 81%, 77% and 73% respectively.In the donor group age 55+, there was significant difference (p&lt;0.0001) between the head trauma and cerebrovascular cause of death prior to 2010, but no difference in the new era. Conclusions: Our study of the UNOS database finds that the donor age of transplanted hearts significantly impacted long-term survival during 2000-2009. These significant differences carry for transplants from 2010-2019, however, we find that long-term survivability for all donor groups increased to over 70%. The largest increase was observed for donor hearts 55+ years where the chance of 10-year survival improved from 40% before 2010 to 73% after 2010.
Abstract 12521: Assessment of Women's Cardiovascular Health Awareness in Lombardy Using Population-Based Web-Survey: The "Call for Women" Project
Authors: Serenella Castelvecchio, Lori Mosca, Lucia Ramputi, Irene Baroni, Brooke Aggarwal, Gianluca Conte, Daniela Mazzaccaro, rosario caruso, Carmela Asteria, Rosanna Cardani, Sabrina Corbetta, Carola Dubini, Sara Boveri, Ambra Cerri, Massimo F Piepoli
Journal: Circulation (2023)

Introduction: In Italy, despite the improvements in outcomes, cardiovascular disease (CVD) continue to be the leading cause of death in women. Hypothesis: The majority of women has no perception of this risk. Goals: Raising awareness among women about their main health threat. Methods: Women (≥18 years) living in the Lombardy region were invited from September 2022 to February 2023 to fill in a web-survey distributed in the general population through a public, anonymous link. Results: Of 2802 women who answered the call, 2217 (94%) completed the survey, including 107(5%) of women not born in Italy. The mean body mass index was 23.5±4.5 kg/m 2 , with 25,8% of responders being overweight. Despite the perception of that weight gain was a serious problem in a high percentage women (42%), 26.4% of them did not perform any physical activity and 38.7% practiced less than the recommended 150 minutes a week. Nearly half (46.8%) checked their blood pressure annually and 38.2% have never had any CV test. Only 35.5% were aware of CVD as the leading cause of death (LCOD) in women and 2.5% indicated stroke as LCOD, while 40.9% still considered cancer as the greatest health threat for women. Awareness was greater with older age and increasing education and lower among unemployed and menopausal women. The main sources of information about health were considered general practitioner (51.6%) and the web (27.0%). Counterintuitively, women not born in Italy mostly use the Internet (40%, p=0.001). Finally, the survey showed that women were aware of seeing public health education campaigns about breast cancer (72.4%) and violence (19.7%) more frequently than of campaigns about CVD prevention(1.3%). Conclusions: Only one-third of all women in this pilot study are aware that CVD is their number one killer. Increasing awareness of CVD as the LCOD among women is a priority, requiring collaboration of healthcare practitioners, professional health organizations, as well as dedication of financial resources.
Abstract 16946: The Optimal Surgical Procedure of Mitral Valve Repair According to Risk Analysis of Postoperative Functional Mitral Stenosis
Authors: Masaru Matsuda, Keitaro Domae, Junki Yokota, Noriko Kodani, Tomohiko Sakamoto, Toru Kuratani, Masatoshi Hata, Takafumi Masai, Yoshiki Sawa
Journal: Circulation (2023)

Background: Functional mitral stenosis (FMS) after mitral valve repair (MVr) is associated with pulmonary hypertension in the late period, increasing the risk of re-operation and deterioration of long-term outcomes. However, the risk factors for FMS after MVr, especially the impact of surgical procedures, have not been thoroughly investigated. Hypothesis: We hypothesize that procedures of valve repair, including prosthetic ring orifice area (ROA), may be associated with FMS in the late period. Methods: We retrospectively evaluated 205 patients who underwent MVr using full annuloplasty rings between 2011 and 2021 at our institution. FMS was defined as mean trans-mitral pressure gradient (TMPG) ≥8 mmHg measured by annual echocardiography. ROA was determined by calculating the internal area of each valve type and size. Perioperative factors such as repair techniques, ROA, and ROA divided by BSA (ROAi) were used to analyze risk factors for FMS. The mean follow-up period was 4.8±0.4 years. Results: MVr was performed using artificial chordae in 110 cases and intervention in valve leaflet in 83 cases (resection suture: 43, cleft closure: 26, plication: 12, and edge-to-edge repair: 8). We also utilized semi-rigid full ring in all cases (26 or less: 15, 28: 53, 30: 73, 32: 49, 34 or more: 15). We identified postoperative FMS in 23 cases (11.2%, 2.5±0.9 years after MVr) with TMPG of 9.0 ± 0.7 mmHg. In the FMS group, decreasing TR-PG in the late period was not achieved after MVr. TR-PG in the late period was also significantly higher in the FMS group (28.3 ± 5.8 vs. 20.3 ± 2.1 mmHg, p=0.01). The freedom from re-operation for MV and re-hospitalization for heart failure rate was not significantly different in the two groups (93.6% vs. 95.5%, p=0.32, 87.7% vs. 90.6%, p=0.36, respectively). However, the freedom from MACE rate was lower in the FMS group (81.4% vs. 86.3%, p=0.11). Univariate analysis demonstrated that intervention in valve leaflet (OR 2.53, p=0.04) and ROAi (OR 0.98, p=0.005) were significant risk factors for FMS. Conclusion: Although further follow-up is mandatory, these results suggested that the use of sufficiently large prosthetic ring and avoidance of intervention in valve leaflet are efficient for preventing FMS and improving clinical outcomes after MVr.
Abstract 15617: Association Between Growth Differentiation Factor-15 and Outcomes Among Patients With Heart Failure: A Systematic Literature Review
Authors: Ali Javaheri, Mikhail N Kosiborod, Mualla Ozcan, Lauren Moubarak, Karen E Smoyer, Michelle I Rossulek, James H Revkin, John D Groarke, Lisa C Tarasenko
Journal: Circulation (2023)

Background: Growth differentiation factor-15 (GDF-15) is upregulated during myocardial injury and stress, and is an emerging biomarker of adverse outcomes in patients with heart failure (HF). Although systematic literature reviews (SLRs) of GDF-15 and HF have been conducted, few assessed outcomes other than mortality. Aim: This SLR examined the association of GDF-15 levels with a broad range of outcomes in patients with HF. Methods: Following PRISMA guidelines, Embase and Medline were searched to identify articles published 1/1/2014–8/23/2022 reporting outcomes associated with GDF-15 in adults with HF. Both cross-sectional (assessed at the same time as GDF-15) and longitudinal outcomes were included. Results: Sixty-three publications met eligibility criteria: 45 were observational studies and 18 post hoc analyses of randomized controlled trials. A total of 19 outcomes were identified. The most frequently reported longitudinal outcomes were mortality (n=32), composite endpoints (e.g., death ± hospitalization; n=28) and hospitalization (n=11). The most common cross-sectional outcome was biomarkers of kidney function (n=22). Of 27 studies assessing all-cause mortality, 24 conducted multivariable analyses (MVA), of which 22 (91.7%) reported a significant, independent association between higher baseline GDF-15 and all-cause death. Among the 26 studies reporting association between baseline GDF-15 and composite endpoints, 19 used MVA and 13/19 (68.4%) reported at least one significant association. Among 10 studies assessing hospitalization and baseline GDF-15, 8/10 (80%) reported outcomes using MVA, of which 50% found a significant association. Twenty studies assessed the cross-sectional association between baseline GDF-15 levels and measures of kidney function. Of these, 7 used MVA and reported statistically significant associations. Conclusions: The results of the SLR suggest that GDF-15 is an independent predictor of mortality and other adverse, nonfatal outcomes in patients with HF. Better understanding of the potential prognostic role of GDF-15 in HF could improve clinical risk prediction and identify patients with HF who may warrant additional treatment optimization/intensification.
Abstract 12544: Point-of-Care Ultrasound Estimation of Right Atrial Pressure Predicts Early Readmission in Patients With Acute Decompensated Heart Failure
Authors: Michael Knapp, Oluwatosin Aluko, Himal Chapagain, Faizan Faizee, Aleesha Kainat, Rahul Chaudhary, Marc A Simon, John Pacella
Journal: Circulation (2023)

Introduction: We previously developed and validated a highly accurate non-invasive, point-of-care ultrasound (POCUS) technique that uses right internal jugular vein (RIJV) compliance to predict elevated right atrial pressure (RAP). We sought to determine whether this POCUS technique would predict 30-day readmission in acute decompensated heart failure (ADHF) patients. Hypothesis: POCUS-based estimation of RAP at the time of discharge can predict 30-day readmission in patients with ADHF. Methods: In this prospective cohort study, consecutive patients admitted with ADHF were screened for eligibility. POCUS images of the RIJV at end-expiration and at maximal expansion during Valsalva were collected daily during the patient’s stay. To assess compliance, the change in cross-sectional area (CSA) of the RIJV induced by Valsalva was calculated using ImageJ and referred to as the distensibility index (DI). From ROC analysis, a DI≥66% was considered negative for elevated RAP while a DI&lt;66% was considered positive (PPV 87%). 30 days post-discharge, readmission data were collected from patients’ EMR and a follow-up phone call. Sensitivity/specificity and predictive value analyses were conducted based on readmission data for those discharged with positive and negative tests. Results: A total of 237 admitted patients were eligible for this analysis. Patients discharged with a POCUS-estimated elevated RAP had a 30 day readmission rate 3.5 times greater than those discharged with normal POCUS-estimated RAP (26.7% vs 7.6%). POCUS-based normal RAP at discharge had a 92.4% negative predictive value (NPV) for avoiding 30-day readmission (P&lt;.001). A subset of patients in this cohort (n=81) were admitted to a local community hospital. In this setting, POCUS estimation of RAP at discharge had a 95.7% NPV (P&lt;.001) for avoiding 30-day readmission, and patients discharged with a POCUS-based elevated RAP had a 30-day readmission rate 9.6 times greater than those discharged with a normal POCUS test (41.2% vs 4.3%) . Conclusions: POCUS estimation of RAP strongly predicts avoidance of 30-day readmission for ADHF. Using this technique to guide discharge planning, potentially to reduce readmission for ADHF, deserves further investigation in a prospective randomized trial.
Abstract 19141: Carotid Artery Plaque Rim Sign on Computed Tomography Angiography is Associated With Intraplaque Hemorrhage and Inflammatory Microenvironment
Authors: Valentina Nardi, Arush Rajotia, John C Benson, Luca Saba, Lilach O Lerman, Amir Lerman
Journal: Circulation (2023)

Introduction: The carotid artery rim sign on CTA is characterized by soft-plaque components surrounded by a rind of thin, adventitial calcification and its role in plaque instability is not established yet. Intraplaque hemorrhage (IPH) and the inflammatory microenvironment in carotid atheroma are considered features of atherosclerotic plaque vulnerability leading to cerebrovascular events. Hypothesis: The association between rim sign on CTA and carotid IPH and inflammation remains scantly investigated. In this study, we aimed to determine whether rim sign is associated with IPH on MRA and with the extent of IPH and inflammation on histology. We hypothesized that rim sign may be a radiological predictor of carotid IPH and inflammation. Methods: We retrospectively enrolled 100 consecutive patients who underwent carotid endarterectomy (CEA) and neck CTA before CEA. On CTA, the ipsilateral rim sign was defined as the presence of adventitial calcifications with internal soft-tissue plaque of ≥2 mm in maximum thickness. Of the included patients, 25 had MRA with 3D magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence. Carotid plaque specimens were collected and stained with H&amp;E to quantify IPH (%). Histologically, we defined IPH as an area of carotid plaque with blood elements, and inflammatory microenvironment as the presence of lymphocytes and plasma cells (chronic inflammation) and foam cells. Results: The rim sign on CTA was present in 56 (56%) of patients. IPH on MRA was present in 11 (44%) patients. The rim sign was significantly associated with the presence of IPH on MRA [9 (81.8%) vs 2 (14.3%); p=0.003]. On histology, the rim sign was associated with a higher extent of IPH [5.0 % (IQR 2.0-25.0) vs 5.0% (IQR 0.0-10.0); p=0.017], with chronic inflammation [44 (78.6%) vs 12 (21.4%); p=0.003], and foam cells [51 (91.1%) vs 5 (8.9%); p&lt;0.001]. Conclusions: These findings suggest that rim sign on CTA may be proposed as a potential imaging marker of IPH as well as a histologic predictor of IPH extent and carotid plaque inflammatory microenvironment.
Abstract 12595: Vascular and Cardiac Ultrasound as the Primary Imaging Tool to Safely Deliver Pacing Leads While Implanting Single Chamber Cardiac Implantable Electronic Devices. RADICAI USE Investigators
Authors: Ahmed T Moustafa, Samuel Triemstra, Ahmed T Mokhtar, Saketh Saravu, Viwe Mtwesi, Lorne J Gula, Peter Leong-Sit, Jaimie Manlucu, Allan C Skanes, Raymond Yee, Anthony TANG, Habib R Khan
Journal: Circulation (2023)

Introduction: Conventional Cardiac implantable electronic devices (CIEDs) implantation requires fluoroscopy. Risks involved with implantation include pneumothorax, lead dislodgement, and perforation of the right ventricular wall. In addition, there are long-term risks of malignancy associated with prolonged and repeated use of radiation over the decades of operators’ employment and mechanical injuries related to heavy personal protection equipment. To reduce these risks, we aimed to study the utilization and safety of ultrasound (US) for the entire procedure to implant single-chamber devices. Methods: The RADICAI USE study (Reduction or Elimination of Radiation Use in Single Chamber Cardiac Devices using ultrasound) is a prospective, single-arm and multi-operator case series enrolled patients awaiting a single-chamber CIED. A fluoroscopic cut-off time of 20 seconds was used to define the success (Group A) or failure (Group B) of using the US for the entire implant duration. Patients were followed up at 1 week, 1 month and 1-year post-implant. Results: The study enrolled 63 patients, with 50 pacemakers and 13 ICDs, a mean age of 79.5 ± 13.8 years (95% CI = 76.1 - 82.9), and a mean weight of 74.1 ± 14.6 (95% CI = 70.5 - 77.7). Overall, 53 (84.1%) CIEDs were successfully implanted with a radiation time of less than 20 seconds (Group A). Fluoroscopic over 20 seconds was required due to poor echocardiographic windows, challenging access, or anatomy. No iatrogenic new or worsening of tricuspid regurgitation was noted. The mean procedure time including US setup time was 65.2 ± 20.2 (95% CI = 60.2 -70.2) minutes. Fluoroscopic time was significantly reduced in Group A compared to Group B (5.8 ± 4.5s vs 109.5 ± 92.9s, p = 0.004). Follow-up showed no device-related complications, with only two patients requiring lead revisions due to poor sensitivity, one unrelated to US use and another probably related. Conclusions: US-guided implantation of single-chamber CIEDs is feasible and safe, reducing the need for fluoroscopic guided implantation and subsequent risks of higher radiation exposure. Further studies are required to evaluate the cost-effectiveness and to explore fluoroscopic-free single-chamber CIED implantations using the US.
Abstract 13816: Clearing P16+ Cells Prevents Cardiac Dysfunction and Death in Mice With Acute Myocardial Infarction
Authors: Mozhdeh Mehdizadeh, Francis Leblanc, Patrice Naud, Yasemin Altuntas, Eric Thorin, Gerardo Ferbeyre, Jean-Claude Tardif, Martin G Sirois, Jean-Francois Tanguay, Guillaume Lettre, Stanley Nattel
Journal: Circulation (2023)

Introduction: Cellular senescence, a stress and age-related response, is often characterized by p16 expression in p16 positive (p16 + ) senescent cells. Senescent cells secrete profibrotic and proinflammatory factors as parts of a “senescence associated secretory phenotype”. The role of cellular senescence in myocardial infarction (MI) is unclear. Aims: To study the effect of p16 + cell clearance on survival, cardiac remodeling and function after MI. Methods: We used INK ATTAC transgenic mice, in which p16 + cells undergo targeted apoptosis upon exposure to a dimerizer, AP20187 (AP). MI mice were treated with AP or vehicle (V), twice a week for 1 month, beginning 3-4 hours post-MI. Cardiac function and structure were evaluated with echocardiography, hemodynamic parameters with a Millar catheter, infarct area with Masson’s Trichrome, gene expression with qPCR and single-nucleus RNA-sequencing (snRNAseq). Results: Survival post MI was dramatically increased in MI-AP vs MI-V mice (P&lt;0.001, Fig A), primarily via prevention of cardiac rupture (CardRup). Left ventricular (LV) ejection fraction (EF%) and LV anterior wall thickness at end diastole (LVAWd) decreased in MI-V vs Sham and improved in MI-AP mice (Fig B), indicating preservation of cardiac function and structure with p16 + cell clearance. Hemodynamic indices of LV function (max and min dP/dt) improved with AP (Fig C). Fibrosis-related gene expression (Col1a1, Col3a1 and Lox; Fig D) increased with MI and improved with AP, paralleling changes in infarct size (Fig E). snRNAseq showed that genes were principally upregulated in MI-V macrophages and neutrophils; significant responses were seen in TNF-α, inflammatory response pathways and gene programs associated with CardRup (Fig F). Conclusion: These results suggest that p16 + cells play a significant role in the evolution of MI, apparently by modulating inflammatory signaling, pointing to an important pathophysiological role of cellular senescence.
Abstract 16099: Life’s Essential 8 and Genetic Predisposition Predict Brain Volume Change, Mild Cognitive Impairment and Dementia Risk
Authors: Qi Wang, Dongshan Zhu
Journal: Circulation (2023)

Introduction: Life’s Essential 8 (LE8) are the key measures for improving and maintaining cardiovascular health, as defined by the American Heart Association in 2022. The associations of LE8 with future brain volume change, mild cognitive decline (MCI), and dementia have been unclear. Hypothesis: We hypothesized that LE8 status might be related to future brain volume change, and predict risk of MCI and all-cause dementia. Apolipoprotein E (APOE) gene and polygenic risk score (PRS) may modify the association between them. Methods: We used cohort data from UK Biobank. LE8 was categorized into low (&lt;50 score), moderate (50-79 score), and high (≥80 score) levels. Genetic predisposition was measured by APOE e4 carrier status and a polygenic risk score (PRS) calculated based on 39 non-APOE genetic variants. Linear regression models were used to analyze LE8 every 10-score increase and change of brain volume (total and hippocampus etc.). Cox regression models were used to estimate the hazard ratio (HR) and 95%CI on the association between LE8 and MCI and dementia. Results: We included 126,785 participants with a mean (SD) age of 56.0 (8.0) years and 53.5% were female. After a median of 13.0 years follow-up, we recorded 1797 (1.4%) people with MCI, and 1055 (0.8%) with dementia. Every 10-score increase of LE8 was related to 2826.11mm 3 increase in total brain volume, 8.41 and 12.04 mm 3 increase in left and right hippocampus volume respectively, while 393.41mm 3 decrease in ventricular cerebrospinal fluid volume (p values all &lt;0.001). Compared to people with a low LE8, those with a high LE8 were associated with decreased risk of MCI (HR 0.54, 95% CI 0.44-0.68) and dementia (0.63, 0.47-0.85). Compared to people with high LE8 and no APOE e4 allele, those with low LE8 and one or two APOE e4 alleles were associated with increased risk of MCI (2.36, 1.69-3.29) and dementia (4.37, 2.86-6.68). The joint effects of LE8 and PRS showed that people with high LE8 and low PRS had lower risk of dementia. Conclusions: High LE8 was associated with increased total brain volume, hippocampus volume and decreased ventricular cerebrospinal fluid volume. Higher LE8 was also linked to reduced risk of MCI and dementia. There were joint effects between LE8 and APOE, PRS on MCI and dementia risk.